We have instituted routine dynamic Intensity Modulated Radiation Therapy (dIMRT). This is the most complex of IMRT treatments and requires considerable pre-treatment verification to ensure accurate execution. These treatments are delivered using our twin Clinac-21EX accelerators. A Hi-ART system (Tomotherapy Inc.) for delivering treatments via helical tomotherapy has been installed, accepted and is currently treating patients. This system provides ROB with cutting edge treatment technology to support future clinical trials. We have started a series of initiatives with our Nucletron High Dose-Rate Afterloader (HDR) , using a small, high intensity 192Ir source for interstitial and intercavitary brachytherapy. Our radiosurgery capability has been expanded with the acquisition of 3 new applicators with diameters of 5mm, 7.5mm and 10mm. A new Philips Brilliance 16 slice, large bore CT Simulator has received couch control upgrades. On-board imaging (OBI) has been installed on the newer Clinac-21EX The oldest Clinac-21EX accelerator has been removed and the room in which it was housed is undergoing renovation and reconfiguration to accept the new accelerator. This new machine is a state-of-the-art Varian TrueBeam STX, which has been purchased and is awaiting delivery. This accelerator will be equipped with the new high definition multi-leaf collimator with leaf widths as thin as 2.5 mm. This will render it capable of performing frameless stereotactic radiosurgery (SRS), although a set of circular collimators and an SRS planning module are included in the acquisition. This will replace our current Radionics SRS system, which has been discontinued by the manufacturer. The patient couch also provides 6 Degrees-of-Freedom (6DOF) to greatly improve positioning accuracy by permitting corrections for pitch, roll and yaw, in addition to the traditional longitudinal, lateral and vertical position adjustments. This machine will include the Edge Extracranial SABR Package that will permit the unit to deliver frameless stereotactic body radiation therapy (SBRT) using advanced motion management based on radiofrequency local positioning using implanted fiducial transponders and infrared cameras. The revised Edge package includes a Calypso radiofrequency positioning system, utilizing implantable fiducial transducers and real-time tracking capability.